<div class="modal fade bs-example-modal-lg" tabindex="-1" aria-labelledby="msg_dialog_title"
     id="modify_address-detail-modal" role="dialog" aria-hidden="true">
    <div class="modal-dialog modal-lg">
        <div class="modal-content">
            <div class="modal-header">
                <a href="javascript:void(0);" title="关闭" class="close" data-dismiss="modal">×</a>
                <h4 class="modal-title">
                    发货信息
                </h4>
            </div>
            <div class="modal-body">
                <div class="panel panel-default">
                    <div class="panel-body">
                        <form class="form-horizontal" role="form" id="modify_address_form"
                              action="javascript:doSendRepreorder();" method="post">
                            <div class="form-group">
                                <label for="bizOrderId" class="col-sm-2 control-label">订单ID</label>

                                <div class="col-sm-10">
                                    <input type="text" id="bizOrderId" name="bizOrderId" class="form-control"
                                           placeholder="订单ID" readonly="readonly" value="${data.orderId}">
                                </div>
                            </div>
                            <div class="form-group">
                                <label for="mobile" class="col-sm-2 control-label">手机号码</label>

                                <div class="col-sm-10">
                                    <input type="text" id="mobile" name="mobile" class="form-control" placeholder="手机号码"
                                           required
                                           data-bv-notempty-message="请输入手机号码" value=${data.mobile}>
                                </div>
                            </div>
                            <div class="form-group">
                                <label for="mobile" class="col-sm-2 control-label">区域</label>

                                <div class="col-sm-10">
                                    <select class="form-control" id="district" name="district"></select>
                                </div>
                            </div>
                            <div class="form-group">
                                <label for="mobile" class="col-sm-2 control-label">送货地址</label>

                                <div class="col-sm-10">
                                    <input type="text" id="address" name="address" class="form-control"
                                           placeholder="送货地址" required
                                           data-bv-notempty-message="请输入送货地址" value=${data.addressSnapshot}>
                                </div>
                            </div>
                        </form>
                    </div>
                </div>
            </div>
            <div class="modal-footer">
                <button type="button" id="modify_btn" class="btn btn-primary">修 改</button>
                <button type="button" class="btn btn-default" data-dismiss="modal">关 闭</button>
            </div>
        </div>

    </div>
</div>

